Colonoscopy-Ascertained Prevalence of Advanced Neoplasia According to Fecal Hemoglobin Concentration in a Large Cohort of Fecal Immunochemical Test–Negative Screening Participants
Authors: Tobias Niedermaier, Thomas Heisser, Rafael Cardoso, Michael Hoffmeister, Hermann Brenner
Journal: Annals of Internal Medicine (2023)

Letters7 November 2023Colonoscopy-Ascertained Prevalence of Advanced Neoplasia According to Fecal Hemoglobin Concentration in a Large Cohort of Fecal Immunochemical Test–Negative Screening ParticipantsTobias Niedermaier, PhD, Thomas Heisser, PhD, Rafael Cardoso, PhD, Michael Hoffmeister, PhD, Hermann Brenner, MD, MPHTobias Niedermaier, PhDDivision of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany, Thomas Heisser, PhDDivision of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany, Rafael Cardoso, PhDDivision of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany, Michael Hoffmeister, PhDDivision of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany, Hermann Brenner, MD, MPHDivision of Clinical Epidemiology and Aging Research, Division of Preventive Oncology, and German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), and National Center for Tumor Diseases (NCT), Heidelberg, GermanyAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M23-1358 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Screening could prevent a large proportion of colorectal cancer (CRC) cases and deaths. Fecal immunochemical tests (FITs) for hemoglobin are increasingly used (1). Time intervals after which a negative FIT should be repeated—that is, annual or biennial FIT screening, or even longer intervals among persons at low risk (2)—are debated. Risk stratification could be done by quantifying fecal hemoglobin concentration.Objective: To provide a dose-response analysis of the association between fecal hemoglobin concentrations and the presence of advanced neoplasia (AN [CRC or advanced adenoma]) in an ongoing study among participants of screening colonoscopy in Germany (BliTz [Begleitende Evaluierung innovativer ...References1. Cardoso R, Guo F, Heisser T, et al. Utilisation of colorectal cancer screening tests in European countries by type of screening offer: results from the European Health Interview Survey. Cancers (Basel). 2020;12. doi:10.3390/cancers12061409 CrossrefGoogle Scholar2. Senore C, Zappa M, Campari C, et al. Faecal haemoglobin concentration among subjects with negative FIT results is associated with the detection rate of neoplasia at subsequent rounds: a prospective study in the context of population based screening programmes in Italy. Gut. 2020;69:523-530. [PMID: 31455608] doi:10.1136/gutjnl-2018-318198 CrossrefMedlineGoogle Scholar3. Brenner H, Tao S. Superior diagnostic performance of faecal immunochemical tests for haemoglobin in a head-to-head comparison with guaiac based faecal occult blood test among 2235 participants of screening colonoscopy. Eur J Cancer. 2013;49:3049-3054. [PMID: 23706981] doi:10.1016/j.ejca.2013.04.023 CrossrefMedlineGoogle Scholar4. Chen H, Werner S, Brenner H. Fresh vs frozen samples and ambient temperature have little effect on detection of colorectal cancer or adenomas by a fecal immunochemical test in a colorectal cancer screening cohort in Germany. Clin Gastroenterol Hepatol. 2017;15:1547-1556 e5. [PMID: 27793749] doi:10.1016/j.cgh.2016.10.018 CrossrefMedlineGoogle Scholar5. Breekveldt ECH, Toes-Zoutendijk E, de Jonge L, et al. Personalized colorectal cancer screening: study protocol of a mixed-methods study on the effectiveness of tailored intervals based on prior f-Hb concentration in a fit-based colorectal cancer screening program (PERFECT-FIT). BMC Gastroenterol. 2023;23:45. [PMID: 36814185] doi:10.1186/s12876-023-02670-1 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Tobias Niedermaier, PhD; Thomas Heisser, PhD; Rafael Cardoso, PhD; Michael Hoffmeister, PhD; Hermann Brenner, MD, MPHAffiliations: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, GermanyDivision of Clinical Epidemiology and Aging Research, Division of Preventive Oncology, and German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), and National Center for Tumor Diseases (NCT), Heidelberg, GermanyGrant Support: By grants from the German Research Council (DFG, grant No. BR1704/16-1), the Federal Ministry of Education and Research (BMBF, grant no. 01GL1712), and the German Cancer Aid (No. 70113330).Disclosures: Authors have reported no disclosures of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M23-1358.Reproducible Research Statement: Study protocol: Available at https://drks.de/search/de/trial/DRKS00008737. Statistical code: Available on reasonable request (i.e., a proposal) from Dr. Niedermaier (e-mail, t.niedermaier@dkfz.de). Data set: Not available.Corresponding Author: Tobias Niedermaier, PhD, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 581, D-69120 Heidelberg, Germany; e-mail, t.niedermaier@dkfz.de.This article was published at Annals.org on 7 November 2023. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics November 2023Volume 176, Issue 11 Page: 1569-1571 Keywords Colorectal cancer Fecal immunochemical test Hemoglobin ePublished: 7 November 2023 Issue Published: November 2023 Copyright & PermissionsCopyright © 2023 by American College of Physicians. 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